HomeMy WebLinkAbout04/17/1990, C-5 - CONSIDERATION OF CANCELLING THE EMERGENCY MEDICAL SERVICES CONTRACT BETWEEN THE CITY AND COUNTY OF MEETM
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city f PO DATE:7
Cl O Sdt'1 LUIS OBIS April l 17 1990
COUNCIL AGENDA REPO 1T°"NUN1Bgt
FROM: Michael P. Dolder, Fire Chief
SUBJECT: Consideration of Cancelling the Emergency Medical Services
Contract between the City and County of San Luis Obispo
which deals with ambulance services.
RECOMMENDATION: Adopt Resolution No. (1990 Series) cancelling
the City's Emergency Medical Services contract with
the County of San Luis Obispo effective May 5, 1990.
DISCUSSION
Prior to 1975. Emergency Medical Ambulance Services within San Luis
Obispo County were limited and lacked coordination. In fact, ambulance
service was provided without City or County control. A grand jury's
review of the ambulance service levels identified a need to improve the
delivery of EMS services.
Beginning in 1976, Cities and the County, under Title 5 of the
Government Code, developed individual contracts to transfer ambulance
service authority to the County in an attempt to provide better
service. Since 1976, county-wide demographics have changed as well as
the medical service levels provided by ambulance companies and Fire
Departments. During the same period the balance of EMS control has
shifted to the County without local input. Therefore, cities met to
restore the balance between the County on EMS issues.
Staff's recommendation in this report to cancel the current EMS
contract and proceed with negotiating a new contract is an attempt to
restore the balance of control. Cancelling this contract will not
disrupt ambulance service to the City. Instead, this action will allow
San Luis Obispo and the other six cities to develop a new contract
which provides for the mutual association of the cities and the County.
After cancelling the contracts our negotiations would be based on
existing Health and Safety and Government Code requirements which
define cities and county EMS response authorities.
The City Managers and City Fire Chiefs of San Luis Obispo County have
jointly reviewed and considered the existing City/County Emergency
Medical Services (EMS) contracts, which deal with ambulance services.
The majority of the contracts are individual agreements between the
County and each city, most of which were signed in 1976 and 1977
(Attachment #1) . These individual City/County EMS ambulance contracts
transfer ambulance service responsibilities to the County for a period
of five years. The contracts also contain an automatic five year
renewal clause unless a one year advance cancellation notice is given.
The City of San Luis Obispo's Emergency Medical Services (EMS) contract
(Attachment #2) became effective May 5, 1976. The opportunity for the
City to modify the contract will be May 5, 1991. However, the City
must notify the County one year in advance or prior to May 5, 1990 of
its intention to cancel or change the existing contract.
�► �u1�eII�A��IN�U city of san Lues oBispo
COUNCIL AGENDA REPORT
Page 2 _
At a February, 1989 meeting the City Managers of San Luis Obispo County
reviewed a report prepared by the Fire Chiefs (Attachment #3) and
unanimously agreed that the current EMS contracts essentially eliminate
local input into the decisionmaking process required to determine the
level of emergency medical ambulance services provided to each
incorporated City. As the report also indicates, a number of contract
changes have been made since the contracts were originally signed
without local input. The City Managers collectively concluded that new
City/County contracts should be negotiated to rectify this inequity.
The basic goal of the City Managers and Fire Chiefs is to introduce
local community input prior to any decision of the County affecting the
level of medical service within their own jurisdictions. To this end a
sub-committee consisting of City Managers Rick Kirkwood and Ray Windsor
and Fire Chiefs Michael Dolder and Paul Henlin was formed to negotiate
a new draft EMS contract with the County for ultimate review and
approval by all cities in the County.
Negotiations began in February, 1989 and after three meetings it was
determined that insufficient ambulance response data was available to
accurately assess the current ambulance delivery services. During the
interim, data was collected and submitted to the Emergency Medical
Services Agency (EMSA) for analysis. The results of the ambulance
performance study was published by the EMSA in January, 1990
(Attachment #4) , some ten months after the committee's original request
was made. Although the EMSA's intent was to analyze the current
ambulance service level, the report's conclusion was that insufficient
ambulance response criteria and response data exist to make specific
findings.
Following review of the EMS ambulance report, the City Manager/Fire
Chiefs' sub-committee resumed negotiations with the County in February,
1990. The sub-committee has concluded that while negotiations continue
it would be best for each city to formally notify the County that it
does not intend to renew the existing EMS contract.
The City of San Luis Obispo's notification needs to occur on or before
May 5, 1990. Notifying the County of our intent to cancel the current
EMS ambulance contract will strengthen our negotiations position. This
action will also avoid having the existing contract automatically
renewed as well as going on record indicating our dissatisfactions with
the existing situation.
FISCAL IMPACT
No additional costs will occur if the City cancels the Emergency
Medical Services contract except for staff time incurred during
contract negotiations. San Luis Ambulance, which serves the City area,
is currently requesting a rate increase which is higher than Santa
Barbara, Ventura and Monterey Counties. Under the City's current
contract there is no review of a rate increase request. Renegotiating
v��
�+►�iIUIP�gI�III city of san Luis oBispo
COUNCIL AGENDA REPORT
Page 3
an EMS contract or administrating ambulance services directly could
reduce ambulance costs to City residents.
CONCURRENCES
The City Attorney agrees that the appropriate action is to notify the
County of our intent to cancel the current EMS contract. This action
will prevent the automatic five year renewal of the EMS contract and
will give the City a stronger negotiating position either individually
or collectively with other Cities. The City Managers and Fire Chiefs
of San Luis Obispo County met on April 6, 1990 and agreed that the
recommended action is appropriate.
ALTERNATIVES
1. Continue contract negotiations without serving notice of our intent
to cancel the existing EMS contract.
2. Do nothing and continue EMS operations under existing contract and
stop negotiations with San Luis Obispo County.
PROS/CONS OF ALTERNATIVES
1. Pro No Council action is required at this time. However, if
negotiations fail, the City will have lost local control
of Emergency Medical Services for the next five years
including the opportunity to review ambulance rate
increases
Con Without serving notice of our intent to cancel the
existing EMS contract, the County may not be motivated to
negotiate a new contract since the current contract
delegates total control of Emergency Medical Services to
the County.
2. Pro No Council action is required. The City will continue to
receive ambulance services under County direction without
local control or input for five additional years. No
additional staff time will be required.
Con Ambulance delivery costs, which currently are higher than
Santa Barbara, Ventura, and Monterey Counties will
continue to escalate without City input or control.
Ambulance response standards will also be established and
regulated by the County without City input.
CAO RECOMMENDATION
Adopt Resolution cancelling the City's EMS contract with the County of
San Luis Obispo.
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11101I11r,ljN city of san tuts osispo
jMING4 COUNCIL AGENDA REPORT
Page 4
ATTACHMENTS
Resolution
Attachment #1 - Comparison of Cities' EMS Contract Initiation and
Renewal Dates
Attachment #2 - City/County EMS Contract
Attachment #3 - Cities Fire Chiefs' Report
Attachment #4 - EMSA's EMS and Ambulance Performance Study
I
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C-5
RESO"TION NO. (19y.r Series)
A RESOLUTION OF THE SAN LUIS OBISPO CITY
., COUNCIL CANCELLING THE EMERGENCY MEDICAL
SERVICES CONTRACT WITH THE COUNTY OF SAN LUIS
OBISPO.
WHEREAS, the City adopted an agreement on May 5, 1976 with the
County of San Luis Obispo transferring the City's Emergency Medical
Services authority for ambulance service to the County for five years;
and
WHEREAS, the existing EMS Contract is automatically renewed for an
additional five-year period unless the County is notified of the intent
to cancel one year in advance; and
WHEREAS, the existing EMS contract does not provide for City input
into County ambulance ordinance changes or changes to the Emergency
Medical Response Manual (EMRM) ; nor does the contract -allow for City
input on ambulance transport charges; and
WHEREAS, since the 1976 contract was signed, numerous changes have
been made without City input; and
. WHEREAS, the changes to the EMS contract have a direct affect on the
ambulance service level to the City; and
WHEREAS, the City Managers and City Fire Chiefs of San Luis Obispo
County have reviewed all City/County EMS contracts regarding ambulance
service levels and found the existing contracts to be lacking
provisions for local input and require modification; and
WHEREAS, it is important to maintain local control and have input
into how ambulance services are delivered to this City and at what
cost;
WHEREAS, population, service demands and county-wide changes have
occurred since the contract was originally signed; and
WHEREAS, it is essential to review and updateemergency medical
services with the involvement of Cities on local control issues.
NOW, THEREFORE BE IT RESOLVED that the City Council of San Luis
Obispo notifies the County of San Luis Obispo that the City intends to.
cancel its current City/County EMS contract effective May 5, 1990 and
directs City staff to evaluate the emergency medical service levels
provided to the City and negotiate a new EMS contract as necessary.
Resolution No. (1990 Series)
Upon motion of _ seconded by
and on the following roll call vote:
AYES:
NOES:
ABSENT:
the foregoing resolution was adopted this day of ,
1990.
Mayor Ron Dunn
ATTEST: __ _ —.-
Pam Voges, City Clerk
APPROVED:
City A inistrative Officer
t tt ne
)Toa=.�2p,
&Qq6aJ—
F`ire Chief
IOL
Attachment....
DATE OF ORIGINAL N(MCF OF NON.RFNRWAL
CONTRACT DATE O ACT RFNFW$ RF11T__ SFFORF
Arroyo C=nde 71111 711 1 7/IM A.G.Council took
mirq�action 9)27198
mumcity 617176 /1191
Pismo h 3/14117 3/14/92-
San
14/92 1 1
515!1 3/5/91 - 5
Morm Bay 519!77 2 _ - mondi
notice of non-renewal
Amscadeto 11/10/801111 5 1R
Paso Robles No contract exists Acdw may m he
requiryd
C���7
Attaent 2--
. . ;
E_: vt COI_TK-'CT 4E^ -�-Ijk'rz 1
TlsiS CONTRACT entered irrtu this %rh 'day of tray
1976, by and between the CITY OF SAN LUIS OBISPO
a general lav .cit; located in the County of San Leis Obispo ,
State of California (hereinafter tailed "City" ) , and the COUNTY
OF SAU LUIS OBISPG , a Political subdivision and one of the
counties of the State of California (hereinafter called "County" ;
LITNESSETH-
WHEREAS , County has dilly adopted an Amhular.ee Ordinance
as set forth in Chapter 6 .60 of the County Code , and pursuant to
such Ordinance., County has also duly adopted an 'emergency Medical
Response Manual (hereinafter called "Ef1Rf1111 , and
WHEREAS, in order to have uniform ambulance operation
1
procedures in the entire County of San Luis Obispo , it is neces -
sary that all cities 'Within the County of San Luis Obispo ; and
the County, enter into contracts pursuant to GovernnIcnt Code
Sections 51300 through 51303 , inclusive , for the performance
by the appropriate County officers and employees of the cities '
ambulance functions , and
WEEP.EAS, Government Code Section. 35794 also permits City
to contract for ambulance service to serve' the residents of City
as convenience requires , and
WHEREAS , it is in the interest of the taxpayers and residents
of the County and of such cities , and it is in the public interes
that such contracts be entered into Sy Ceun_'_v and slush cities
r
11011 , THEREFORE , in consideration of the miutual covenants, �
conditions , promises and agreements h2 rein sit T'Grth . City and
County hereby mutually covenant and agree as follo%•:s : C—S�►"
1 - Tha • the recitals ;_t forth her ir,abova are :.ru_ ,
correct and 'valid. '
2. That pursuant to ra,_rnnent Code .action_ 51300 thre5ugh
51302 , inclusive , and to GG•r_r-n„:ent Code` Section 338794, County
shall by its appropriate officers and emiplcyees oe'rform within' ,
City all of City ' s ambulance functions , including , but not limi-c
to , those referred to is Goverment Code Section 38794.
3. That Cit; and Count; hereb: agree that durine the term
of this Contract , tii-d '.rrovisiens of the County k^bulanee Ordinate
(namely., Chapter 6 .60 of the County Code ) and as hereafter amend,
and of the.'E RtS nd as h2re_fr_2r ar.•ande-d s! -I' be and are in fu"
force and effect within Cita ; and Chanter 5 .60 of the County Cod;
and as hereafter amended , and the ENP`' Of County and as hereafte
amended; are both hereby exeressly incorporated herein by refer=,
as though here fully set forth .
4. The terra, of this Contract shall be for five (5 ) years
from and after the date set forth hereinabove , and such term she'
be automatically renewed fcr additional periods of five (5) year
each unless the legislative body of either County or City votes
.not. te; renew the terse at a meeting more than one. ( 1.) year before
the expiration of any five year period and duly ,notifies the
other party hereto withiin thirty ( 30 ) days after such vote :
5. The following County off 1Cc^rS dna eTpiGyE'e5. Siidll
exercise within City the --c;!ers , duties an_ functions hereinafte
specified :
a . The San L_is Obispo County C;:ergency Medical
Care Corniiiitee shall exercise v:"hin City all of
r
the powers , duties and functions conferred on such
Committee by such Chapter 6 .60 and as hereafter
amended , and by the UIR I and as hereafter as�d ,
= 'to be -exerci-e,. .it:$ Ccunty .
b. The �un.ty -SFT: :f as r.� ef:PH licensing agency
shall exercise within City -all of the powers , dutiez
and functions r.,nferrec on s;;ch Sher i-ff by such.
Chapter 6 .60 anc as. hereafter ar..end_d , and by the .
EMR.M and here_`ter amended , to be Ezercised with-
in, County .
C. The Count; Central Dispatcfi Center shall exercise
within City all of the pot-:ers , duties , and functicn
conferred on s:ch Ce-ter by suchACh-apter6 .60 and a
hereafter a.-.er..__ , and by the EMP.", and as hereafter
amended , to be exercised within County .
d . The Board of Supervisors of Count;; shall exercise
within City all of the powers , du.ties and funct '
conferred on such Board by such Chapter 6 .60 and
as hereafter amended , and by the E1-i%'1 and as hereat
amended , to be exercised within County .
' e . The County Cor^runicat; on Director shall exercise
within City ali of the potters , duties and function
conferred on such Director by such Chapter 6 .60 3r
as hereaftEr .=_nended : and by the and as
hereafter ed , to be exercised .-ithin County .
6 . This Contract may only be amended or repealed by the
mutual written agreement of both perties hereto :
7 . it is understood a+ : agreed by County and City that.
City shall have no obligation or d; _y pursuant to this Contract
pay any money to County for any purpose hereunder .
S. County shall defend , indemnify and save harmless City
and its offs rs , agents a- r-oploye_s � om and against .any and
�~ all claims , demand; , yyi • y.
ccs.:_ - expenses , Judgments , cau
of action and damages , arisir.- in dry manner opt of this Contra
or out of the performance o ittempt d oerfor-artce of the
pro-
visions hereof, including b :. not limited to any act or omissio
to act on, the part Of Count., or it: agents or employees or in-
dependent contractors diracti ;• responsible to County .
9 . e-r: part} hereto shall
assign or transfer this
Contraci or any interest her=is thout the prior written copse
:c.f-tfe other party , except a.: may be other4is4- soeci `icall
y per
µ: ted such Chapter 6 .60 a-d as her y :r.
eafter amended or by such
EVIRK 2nd as hereafter araende;.°
10 . This Contract shall be binding or the assigns . transfe
and successors of the parties hereto .
�;' 11 •
No waiver by either party, hereto of any failure by the
other party to corPly _:•rith an;• terra or condition hereof , shall
be or shall be deemed to be a waiver by such first party of any
similar or other failure by such other party to comply t:ith any
term or condition hereof.
In -witness whereof, City and County have executed this
Contract on the day and yeer first hereinabove set `orth.
City of
f
Fiaycr of City
i
L6u.^.tL• 6f San Luis Obispo
By : /s/ Hans Heilmann
Chirp;an of the Board of
Supervisors of County
1
Approved as to fore
by the City Attorney of
the City of.
--Ci y Attor ey
Approved as to form,
ROBERT N . TAIT
Distric,t Attorney
By :_-
Deputy District ttoi-ney
✓ c-s^�z
i - Attachment
TO: City Managers of San Luis Obispo County
FROM City Fire Chiefs of San Luis Obispo County
SUBJECT: City/County EMS Contract
DATE: February 23, 1989
BACKGROUND - Beginning in 1975 the Cities of Morro Bay, Pismo Beach, Arroyo Grande,
Grover City, San Luis Obispo, Paso Robles and the County of San Luis Obispo developed
contracts to provide ambulance services within the County of San Luis Obispo. Each of
the respective Cities signed similar contracts with the exception of Pismo Beach and
Morro Bay. Atascadero signed an EMS contract at the time of their incorporation.
Pismo Beach and Morro Bay contract's included various covenants which restricted the
counties ability to increase rates and/or to limit various EMS functions performed in
their particular city. In all signed EMS contracts reference is made to an undated
County Emergency Medical Response Manual (EMRM). The EMRM is a procedural
document which regulates the performance criteria for pre-hospital emergency medical
services both public and private. The existing contracts allow the County to modify the
EMRM without City input and/or comment. At the time contracts were signed, the
EMRM did not significantly impact City EMS operations performed by their respective
Fire Departments. However, the most recent EMRM•Ieysion,,not yet adopted would have
significant im rtt emergency response requirements. �—
The existing EMS contracts compel a City to continue the EMS/County relationship
without change for a 5 year period. The exception is Morro Bay which has a yearly
renewal option. Since the signing of these contracts the County has made numerous
procedural changes which include:
1. Eliminated the Emergency Medical Care Committee and created a non-profit
private corportation known as the Emergency Medical Services Agency (SMSA);
granting the EMSA all authority and responsibility conferred on the county by
the cities' contracts and state law.
2. Revised the EMRM in 1982 and adopted revisions. This revision, without city
input, changed the responsibilities and benefits affecting the cities.
3. Redrafted the EMRM in 1988 without City input (not yet adopted) and
increased the impact discussed in 02 above.
4. Considered ambulance contract revisions which include exclusive operating
areas for private ambulance companies, further restricting local determination
of delivery levels, cost and quality of service. Current City subsidies provided
by free Fire Department services would also continue. Exclusive operating
areas could further increase the city subsidized ambulance rates in county
areas.
Since 1975 Emergency Medical Service levels within the County have undergone
significant changes which include:
1. The transition from a standard first aid training and service level to EMT-I,
then to EMT-II and presently an EMT-Paramedic training and service level. In
addition, the type of medical calls responded to, such as hazardous materials
V25-(24) 2/23/89 1
or radiological incidents, require more technical knowledge and increased
training levels as well.
2 Significant population increases and service demand increases.
3. Implementation of a County wide 9-1-1 system.
Cities under the Health and Safety Code Section 54980 are authorized to provide
Emergency Medical Services which include ambulance services. Existing contracts
between the County and Cities transfers the Cities ambulance authority to the
County without sufficient reviews and approval mechanisms. The County presently
can and has changed ambulance service standards and rate structures without City
input or approval.
However, ambulance service rates are based upon service runs including dry runs,
and all operating and maintenance costs for the total ambulance service area rather
than geographic response zones. Other than mileage, ambulance cost between
operating areas are exactly the same. If a medical incident occurs across the street
or in California Valley, the rate is the same. Added service levels and support
provided by Fire Departments are not reimbursed to the local agency nor is the
patient's cost of service reduced. Cities are, therefore, significantly subsidizing
ambulance rate structures in county areas.
The-C"lt danagers 0 —San Luis Obispo County met with County Fire Chiefs to
discuss the existing situation and Cities options to either collectively or individually
correct the ambulance service inequities and loss of local control within their
communities. The Fire Chiefs have researched the existing contracts (Attachment 1)
and Health and Safety Code Sections which apply to Emergency Medical Service.
The Fire Chiefs have identified five alternatives relative to the existing contracts.
i
ALTERNATIVES
1. Revise the existing County/City ambulance contracts to include references to a
specific EMRM, the EWA and Ordinance 660. This would permit City input into
proposed EMRM changes.
2. Develop a new County/City contract. This would provide sufficient safeguards to
protect the City's interests and options involving emergency medical service, the
ambulance delivery system and rate structuring.
3. Replace the existing county EMS contract and the EWA lines of authority with a
J.P.A. This would permit the County and Cities to jointly regulate the management
of emergency medical and ambulance services.
4. Dissolve the current EMS contracts at their renewal dates. This would allow all
agencies to operate independently in providing EMS and ambulance service.
5. Do nothing; allowing the existing contracts to automatically renew themselves. This
would continue the present situation.
V25-(24) 2/23/89 2
Some of the arguments for and against the atlernatives are:
�.
1. Revise the Existing QWnty/qty Ambulance Coniracts to Include a Reference to a
320e1fic EMRM the EMSA and Ordinance 660.
Em - The emergency medical system continues as is with the exception that
cities would have input into any EMRM changes. This alternative would
require less City staff time since the system would be managed by the
EMSA with increased City involvement when EMRM changes are
proposed.
S�lstll - Only limited local control and input would be available. Local input
would be sought when changes are suggested. In the referenced EMRM
cities would continue to subsidize ambulance costs in county areas in that
basic rate structures other than mileage costs are not based on actual
area response costs. In pursuing only limited revisions to the EMS
contract cities would be:prevented from establishing individual
performance standards and/or rate structures. In addition, the existing
contract does not provide sufficient representation on the EMSA board
nor does it include a process for appointing or recommending
representatives to the EMSA except through the Board of Supervisors.
The current EMSA board structure is predominantly composed of special
interest representatives, i.e. physician, nurse, awdicsr pso"ders;citizens
at large with current or previous medical service affiliation background,
and lacks City and general public interest representation.
2. Develop a New County/ itv Contract Which Provides Sufficient Safeguards to
Protect the City's Interests and (lotions Involvinst Emergency Medical Services and
the Ambulance Delivery system and Rate Structuring.
PrQ - This option provides sufficient flexibility in meeting each City's local
needs for medical and ambulance services and at the same time creates an
opportunity to coordinate EMS delivery. The alternative restores local
control and allows cities to establish service levels within individual
boundaries. The contract could provide the following: the ability to
review and approve ambulance service rates and reduce City ambulance
subsidy for response to county areas. The ability to more frequently
review and reconsider the contract, i.e. one year vs. 5 year period. This
alternative allows a city to operate from a standard contract with local
options to address specific community issues and concerns.
Con - The ambulance rate structure for responses to county areas may increase.
The rates for unincorporated areas should reflect the areas actual cost
of providing service. This alternative may require the formation of
county service districts and/or assessment districts in order to pay for
actual ambulance costs.
3. Replace the Existing County EMS Contract and the EMSA Lines of Authority with a
J.P.A. Whereby the County and Cities Jointly Regulate the Management of
Emergency Medical and Ambulance Services
Pro - This alternative maximizes local control and allows the cities and the
county to jointly coordinate medical response, system operations and
program administration. The JPA provides the most immediate and direct
V25-(24) 2/23/89 3
C-S'-15
. . . involvement in the delivery of emergency medical services. J.PA.'s have
proven effective in dealing with medical insurance and similar benefits
and could potentially do the same for EMS.
SBS - The J.PA could require significant staff time in order to act on the
specific programs and responsibilities. The insertion or addition of a
J-PA into the existing situation could introduce time delays and unneeded
bureaucracy. The level of staff expertise assigned to the J.P.A. might
initially be technically deficient and if not planned properly, could cause
initial disruption in the current delivery system. The cities establishment %
of a J.P.A. might require financial subsidies. Impacts on city staff time
could be 2 - 3 meetings/month or more. To our knowledge, no J-PA.
exists in the State of California which regulates EMS as proposed by this
alternative.
4. Do Not Develop a Joint FMS Contract• Allow All Agencies to Operate r..,t'.,.ndently
to Providin¢ EMS and Ambulance Services
- Independent contracts or services would provide the greatest opportunity
for local control with a minimum of direct city cost. Thisalternative
provides an opportunity to improve service levels and design specific
emergency medical services based on local needs and desires. Each city
would maintain the ability to contract with the county for delivering all
Ambulance/EMS`seto;ces. . The local agency may provide more ambulance
units if an increased level of service is desired and if it is willing to
assume the additional cost.
Con - EMS/Ambulance Services operating independently could provide the
highest cost consequences for the county. The independence and
autonomy of the service delivery could produce a disjointed service
especially in a
disaster
situation where e mutual aid resources are required
and coordination has not been built into the system. Operating as
individual. cities does not provide the coordination opportunities that
Alternative #2 provides.
5. Do nothine allow the existing EMS contracts to automatically renew themselves.
Pro - The county will maintain full control over EMS issues. No additional
staff time will be required.
Con - The cities will continue to transfer local control of EMS issues to the
county. Ambulance rates in county areas will continue to be subsidized
by consumers and cities in incorporated areas. The five year renewal
periods will be the only change period where individual city can address
local needs.
RECOMMENDED ACTION:
The Fire Chiefs have reviewed all the alternatives and recommend the following:
A. Agree on a common goal to maintain local control with City/County cooperation and
allow local communities to determine the level of emergency medical services within
their own jurisdiction.
V25-(24) 2/23/89 4
B, Notify the county that the cities request contract renegotiations begin immediately.
In addition.daring a 64 day'interim period no county action should be taken which
would change the existing program including modifications to the EMRK Ordinance
- 660, EhMA or creating exclusive ambulance operating areas
C. Choose Alternative 02 and develop a new county/city contract which provides
sufficient safeguards to protect the City's interest and options involving emergency
medical services, the ambulance delivery system and rate structuring.
V25-(24) 2/23/89 5
C-5-17
Attachment
SAN LUIS OBISPO COUNTY
EMERGENCY MEDICAL SERVICES AGENCY
EMERGENCY MEDICAL SERVICES SYSTEM AND
AMBULANCE PERFORMANCE STUDY
JANUARY 18 , 1990
EMS AGENCY BOARD OF DIRECTOR
SUB-COMMITTEE MEMBERS
PAUL HENLIN
PATTI HEMPENIUS, R. N.
JULIE SCHULTZ, R.N.
JERRY JAMES , EMT-P
PATRICE OWENS , R.N .
EX OFFICIO MEMBER
G.B. ROWLAND, M . D.
EMS AGENCY STAFF
STEVE DARGAN, ADMINISTRATOR
LORI LADWIG, ADMINISTRATIVE ASSISTANT
i
INTRODUCTION
In J-uly 1968, the -California- Legislature adopted sections of the Health
and Safety Code requiring County Boards of Supervisors to appoint an
Emergency Medical Services Committee to review annually local delivery
of Emergence- Medical Services (EMS ) .
In 1974 , the San Luis Obispo County Grand Jury recommended a County
Ambulance Committee be established to rate ambulance service and to
recommend and formulate training standards.
In response to the Grand Jury's recommendation, the County Board of
Supervisors established an Ambulance Committee and directed them to
draft an Ambulance Ordinance and Emergency Medical Response Manual .
The completed draft was presented and approved in concept in October
1974 . As a result of this draft , the Supervisors established the
following:
1 ) Emergency Medical Care Committee (EMCC)
2 ) Clearly defined ambulance service areas
3 ) Seek Joint Power Agreement
4 ) Seek prime contractors
In November 1974 , a State plan for EMS was developed outlining
requirements of the county, region, and state for a local EMS system
plan.
In March 1976 , the EMCC submitted the final draft of the Ambulance
Ordinance and the Emergency Medical Response Manual (EMRM) to the Board
of Supervisors for approval . This final draft was approved by the
Count- after negotiations with the County Ambulance Association.
The EMRM was revised and adopted in December 1982 by the Board of
Supervisors. The present ambulance system within San Luis Obispo County
is administered under this 1982 version.
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This version does not reflect the change in the level of ambulance _
service available, EMT-I vs. EMT-p, nor does it set response performa'
guidelines to act as standards when evaluating the performance of
individual ambulance units or companies.
In August 1989 , the Sheriff's Department denied a request by Special
Services Ambulance for an Ambulance Service License to operate out of
Service Area Four. Special Services Ambulance then filed an appeal with
the San Luis Obispo County Emergency Medical Services Agency Board of
Directors .
At the applicant 's request, the EMS Agency undertook the task of .
reviewing the County' s EMS system and the performance of ambulance
providers .
PROPOSAL
This study will concentrate on the period 1980-89. Questions have been
raised concerning ambulance service now available within the County.
They include :
- Is current ambulance service in the County adequate?
- Are the current ambulance service areas adequate?
- Is it appropriate to use a paramedic ambulance to handle non-
emergency transfers?
- Should response time standards for ambulance providers be set'
- At what point in time should the .County require additional
ambulance services?
- How should the presence of a.•frst responder Advanced Life Support
(ALS) fire department affect :ambulance response performance?
- Should Special Services Ambulance be granted a. County Ambulance
License in Ambulance Service Area Four (4 ) ?
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HISTORY - SAN LUIS OBISPO COUNTY 1980-1989
One factor that directly affects the ability of an EMS system to provide
emergency medical care is population.
During the 19801s, San Luis Obispo County and its incorporated cities
have experienced steady growth in population. These population
increases have produced additional demands on EMS resources. The
Journal of Emergency Medical Services has estimated that nationwide,
there is one EMS request per 109000 population per day.
Figure 1 shows the growth of San Luis Obispo . County for the period
1980-1989 and projection for the years 1995 and 2000.
FIGURE 1
FPopulation by City
Ambulance % Increase
- 1980 Servi�Area - Projected
.1989 1980-1989 1995 2000
Total County 156,900 212,075 35%
242,834 266,192.
Arroyo Grande - Area 6 11,306 14,057 24%
15,702 17,168
Atascadero - Area 4 16,340 22,725 39%
27,213 30,810
Paso Robles - Area 2 9,220 16,392 78% 22,278 26,565
Grover City - Area 6 8,890 11,471 29%
12.748 14,194
Morro Bay - Area 3 9,120 10,133 11%
10,749 11,137
Pismo Beach - Area 6 5,400 7,566 40%
9.040 10,276
San Luis Obispo - Area 5 34,490 419027 19%
449638 47,826
Unincorporated 60,800 88,703 31%
100,416 108,217
Source: California State Department of Finance Figures
\\\ 3
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i
Population for the unincorporated areas of San Luis Obispo County as of
May 1989 and projections for the years 1995 and 2000 are shown in
Figure 2.
FIGURE 2
Population by Planning Area
Ambulance
Service %
Area Areas Jan 80 Jan 89 Inc . 1995 2000
2 Adelaida N/A 2,813 N/A 3 , 034 3 , 189
2 E1 Pomar/Estrella N/A 6 , 126 N/A 7 , 281 8, 127
3 Cayucos 21329 2 ,974 27% 3 , 188 3 ,239
3 Los Osos 11 ,000 14 , 469 31% 15 , 0.13 15 , 547
3 Estero ( rural ) N/A 1 , 625 N/A 1 , 724 1 , 793
6 Huasna crural ) N/A 783 N/A 807 823
4 Las Pilitas N/A 1 , 253 N/A 1 , 359 1 , 433
4 Los Padres N/A 294 N/A 312 325
2 Her-Ranch/Oak Shores N/A 1 ,918 N/A 3 , 439 4 , 76' `•
1 Cambria 3, 103 4 , 850 55% 5 , 591 5 ,873--
1 North Coast N/A 861 N/A 971 1 ,012
2 San Miguel N/A 1 , 066 N/A 1 , 278 1 , 441
4 Santa Margarita N/A 1 , 198 N/A 1 , 361 1 ,414
2 Templeton 1 , 259 2, 719 116% 3 . 241 3 ,487
2 Salinas River (rural ) N/A 5 , 070 N/A 6 , 212 7 , 218
5 Avila Beach N/A 1 , 025 N/A 1 , 037 1 ,045
6 Oceano 4 ,579 6 , 288 37% 7 , 083 7., 660
5 San Luis Bay ( rural ) N/A 3 , 900 N/A 4 , 431 4 ,821
5 San Luis Obispo ( rural ) 7 , 490 11 , 703 54% 12 , 382 12, 933
2 Shandon-Carrizo N/A 2 , 281 N/A 2 , 482 2,624
6 Nipomo and Nipomo Rural N/A 15 ,425 N/A 17 ,597 19, 190
Source: San Luis Obispo County Department of Planning and Building
Figures (Constrained Growth Figures )
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San Luis Obispo County is also home to a large transient population made
up of tourists and Cal Poly students.
The San Luis Obispo County Visitors and Conference Bureau estimates that
the transient population increases the County population by 17% per
year. The impact of such an increase on the EMS system could mean an
additional four EMS calls per day generated by the transient population. -
Combining the permanent and transient populations and applying the
Journal of Emergency Medical Services theory, San Luis Obispo County
should expect 25 EMS .requests per day)
HISTORY - EMERGENCY MEDICAL SERVICE 1980-1989
Emergency medical care has changed considerably during the 1980 's .
By 1989 , in_„all,."areas of the County, expect for the City of Arroyo - "`-
Grande, the first responder, typically the fire department, provides the
initial care while awaiting the arrival of the ambulance.
The care provided by these first responders ranged from basic first aid
F to the EMT-1 level ,
In some communities , such as the City of Arroyo Grande , where local fire
department response is delayed, law enforcement is sometimes available
to help the ambulance personnel.
i
In 1980 , the California Highway Patrol (CHP) became involved in a pilot
project to bring officers from selected areas of California up to the
EMT-1 level to provide quicker medical care. In San Luis Obispo County,
these officers were initially stationed at the Templeton office of the
California Highway Patrol . Since January 1986, all officers graduating
from the CHP Academy are now certified at the EMT-1NA level .
In 1981 , the EMS Agency was formed to train ambulance and firepersonnel
to the EMT-II level : EMT-II training began in early 1982.
p
5
The first medics Were placed in the field in early 1983 .
Initially, six providers were involved in the EMT-II training program. ,,
These providers were: Five Cities Ambulance, San Luis Obispo City Fire_,
San Luis Ambulance, North County Ambulance, Professional Ambulance,
Morro Bay Fire Department, and the Cambria Hospital District.
In January 1985,, the South Bay Fire. Department started providing EMT-II
level of care to the residents of Los Osos/Baywood Park.
In February 1986 the Atascadero Fire Department (AFD) started providing
EMT-II level 'of care to the residents of Atascadero out of their main
station. In 1988 ; AFD started EMT-II service out of their newly
completed Station 2 .
"It was the general intention of the EMS Agency that 24-hour Advanced
Life Support (ALS ) service be developed, 'available and cost effective in
all densely populated areas of. San Luis Obispo County, and that
24-hour BLS service be available throughout the remainder of the County,---,
where ALS services are not justified by service volume and economic
feasibility-1 .
Although 2'4-hour ALS ambulance 'service has not been achieved on a
Count--wide basis 100% of the time, the EMS system has been able to
pro. ide 98% ALS service with the use of both public and private ALS
providers .
In 1.988 , the EMS Agency expanded the prehospital level of care to
include the EMT-P scope of practice. At present, 42 persons are
certified at the EMT-P level . Seven EMT-II 's are awaiting upgrade to
the EMT-P level . This final upgrade is expected to take place in early
1990 .
In addition to the inclusion of EMT-P's into the EMS system, many
changes have occurred within the Basic Life Support (BLS) field.
Process and Criteria for Designation of LALS Providers EMSA 1982
6
Previously, EMT-I level training ( 100 hours) was the only type of EMS
training available for the BLS responder.
In 1988 , a First Responder Training Program consisting of 40 hours of
instruction was started geared for volunteer fire departments. This
program was accepted as a mechanism where members of volunteer
departments could receive needed training without much disruption to
their outside lives .
Also in 1988 , a six-hour course was developed to provide dispatchers
with some basic knowledge about EMS and emergency medical care.
In 1989 , a Public Safety Medical Training Program ( 16 hours ) was
implemented to meet the requirements of Penal Code 13518. This program
meets the minimum requirements for police officers , firefighters, and
lifeguards .
In January 1989 , the use of early defibrillation was added to the BLS
scope of practice . At present early defibrillation is available through
the County, Cayucos , Pismo Beach and Oceano Fire Departments.
HISTORY - AMBULANCE SERVICE 1980-89
In March 1976 , the County amended Title 6 of the San Luis Obispo County
Code and added Chapter 6 . 60 to regulate ambulance service.
Within this new chapter was the development and designation of ambulance
service areas .
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7
I
The 1976 version of the County EMRM was the first try at setting
ambulance service areas. Quoting from the 1976 EMRM, "Ambulance servi�
areas have been created to accomplish effective and timely handling of
most emergency occasions requiring an ambulance. These areas form a
. base of operations from which an ambulance company may be dispatched. "
The 1976 EMRM established the ambulance service areas that are being
used ( see Attachment 1 ) .
Attachment 2 shows the ambulance service adopted in the 1982 revision of
the EMRM. The 1976 EMRM also specified where ambulance base locations
shall be . The mandating of locations for each ambulance service area
base of operations was discontinued in the 1982 revision of the EMRM.
The 1976 version of the EMRM projected the population of each ambulance -
- service area . Using information provided by the State Department of
Finance and San Luis Obispo County Planning Department, comparisons from
1974 to 1989 and projections for the years 1995 and 2000 are shown in
Figure 3 .
I I
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T'hef EMS Agency would like to thank the following individuals for assisting
in the development of this study and for their review of the facts it
contains.
Nikki Dollahite, Sheriff's Department, Med-Com
Vince Morici , County Office of Emergency Services
Capt. Doug Blangsted, CDF/County Fire
Chief Mike Hicks, Atascadero Fire Department
Sgt. Steve Bolts , Sheriff's Department
Lt. Dick Sabath , California Highway Patrol
Dave Melendy, EMT-P, Cambria Hospital District
Dana Shaheen, EMT-II , Five Cities Ambulance Service
Bob Fuller, San Luis Ambulance Service
Chief John Paulson, Cal Poly Fire Department
Chief Lee Friedman, CDF/County Fire Department
Dale Ashburn, San Luis Ambulance Service
Dave Barr, R.V. , Special Services Ambulance
Chief Mike Dolder, San Luis Obispo Fire Department
Frank Kelton, San Luis Ambulance Service
28
j L
FIGURE 3
Ambulance
Service 1974 1989 1974-1989 ProJection2
Area Population' PopulatioW % Increase 1995 2000
1 29806 5,711 50% 69562 6,885
2 13,766 389493 64% 49,305 57,416
3 18,471 29,201 37% 30,704 31,716
4 169561 25,470 40% 30,245 33,982
5 419945 57,655 27% 62,488 66,625
6 35,339 55,590 36% 63,027 69,311
1974 EMRM Projections
2 San Luis Obispo County and California State Department of Finance Projections
The 1982 version of the EMRM states, "The Board of Supervisors may, by
resolution, establish as many ambulance service areas in the County as
it determines to be required. "
The EMRM also states , "Ambulance service areas will be geographically
described by resolution and shall .be drawn so as to provide the
residents within the area of the quickest possible response time in the
event of an emergency. "
At present, County Code 6.60 .-and the _EMF2M do 'not" provide a mechanism to
rate whether or not the current?ambulance=service= areas are laid out to
provide the:,quickest respon.s� .--- im
e•a
....,.�
i
t -
9
5) -02 7
I•n 1980, ambulance service for the County was provided as follows:
Ambulance Service Area One (Harmony north to the Monterey County line
and east to Cypress Mountain Road) - Cambria Hospital District providing
one ( 1 ) full-time ambulance and one ( 1 ) ambulance on call-back status.
Ambulance Service Area Two (Templeton north to Monterey County line,
west to Cypress Mountain Road and east to Kern County line) -
Professional Ambulance providing one full-time ambulance and one ( 1 )
ambulance on a call-back status .
Ambulance Service Area Three (Harmony south to Cuesta College and east
to Cerro Alto Campground) - Bay Ambulance providing one ( 1 ) full-time
ambulance.
Ambulance Service Area Four (Cuesta Grade north to Templeton, west to
Cerro Alto Campground and east to Kern County line ) - North County
Ambulance providing one ( 1 ) full-time ambulance and one ( 1 ) ambulance on
call-back status.
Ambulance Service Area Five (Cuesta Grade south to Avila Road and north
to Cuesta:CQaa gpj�--- -San Luis Ambulance providing two (2) full-time
ambulance units.
Ambulance Service Area Six ( Avila Road south to Santa Barbara County
line and east to Lopez Lake ) - Five Cities Ambulance providing two ( 2 )
full-time ambulance units on weekends and one ( 1 ) full-time unit and one
( 1 ) call-back unit on weekdays .
Additionally, the South Bay Fire Department provided ambulance service
for the residents of Baywood Park-Los Osos on a full-time basis.
The 1982 EMRM provides that under the direction of Central Dispatch
(Med-Com) , ambulance. units;tp�gyld.-be -moved into other, servL-celsr.`
the purpose::of � rovidiri_'__�liivance.:response. if the_`aesigna' r
�rere`_:riot:�ava'iIabl_`e:• -
10
C-s-�
In May 1982 , San Luis Ambulance acquired Ambulance Service Area Three
from Bay Ambulance Service. San Luis Ambulance continued to offer fu:
time service with one unit. Back-up ambulance service was handled by
units from ambulance Service Area Five.
In August 1.983 , San Luis Ambulance acquired Ambulance Service Area Two
from Professional Ambulance. San Luis Ambulance continued to offer
full-time service but dropped the use of the cal-1-back unit choosing to
use units from Service Areas Four and Five as backups .
In August 1984 , the South Bay Fire District dropped the use of their
ambulance service opting to use the private ambulance unit out of Morro
Bay. This action placed additional burden on the Morro Bay unit and
' units in Area Five which are now required to cover Area Three.
In April 1987 , San Luis Ambulance acquired Ambulance Service. Area Four
from Atascadero Emergency Medical Service., thesuccessor to North County
Ambulance . San Luis Ambulance continued to provide one full-time unit
but dropped the call-back unit choosing to use the ambulance from Arer
Two as its primary back-up. When the ambulance in Area Two is not
available , units from Area Five provide coverage:
In 1987 , San Luis Ambulance added a part-time 'ambulance to their station
in Area Five. This unit was responsible for handling most of the
non-emergency transports that start in Area Five. The availability of
that unit is estimated at 25-30 percent over the last two years.
Since the implementation of EMT-IIs, and finally EMT-Ps, four fire
departments, San Luis Obispo, South Bay, Morro Bay and Atascadero , have
become involved in providing ALS care.
11
1 C-�s-a9
In summary, in 1980 there were six ambulance services and one fire
department providing ambulance transport through eight full-time and
four part-time/call-back units. By 1989 , there were three ambulance
services providing ambulance transport through eight full-time and two
part-time/call-back units', a reduction of two part-time/call-back units.
In 1988 , the County of San Luis Obispo issued an. Ambu lance License to
Special Services Ambulance. This license is limited to stand-by service
only. This company is not available to respond to every day EMS
requests . ,
As the population of San Luis Obispo County rises, so do the requests
for ambulance service.
Based on statistical information provided by the Sheriff's Department
Med-Com, Figure 4 shows the increase in ambulance requests starting in
1984 . Information for those years before 1984 is not available.
I
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.-Figure 4
Dry Runs Non-Emergency Referred to
Total Amb. No Transport Transfers ALS Responses Santa Barbara
Year Requests (%) (%) (%) County
1984 9,247 N/A N/A 1,574 ( 17%) N/A
1985 9,916 N/A N/A 1,833 (18.5%) N/A
' 1986 10,609 2,813 (27%) 2,533 (24%) 2,159 (2095) N/A
1987 10,845 2,299 (21%) 2,037 (19%) 1,565 (14.4%) N/A
1988 119380 2,627 (23%) 2,642 (23%) 2,048 (18.0X) 24
1989 11,517 39131 (27%) 2,103 (18%) 2,736 (24.0%) 47
For 1989, San Luis Obispo County averaged 25.8 ambulance responses per day.
12
As Figure 4 shows , San Luis Obispo County has experienced a 23% increa
in the demand for ambulance service from the period 1984 through 1989( ,✓)
With the increase in population and demand for ambulance service, the
private ambulance providers, with the EMS Agency and Med-Com, developed
an ambulance move-up system trying to provide more consistent coverage
throughout the County. '
The County-Wide Ambulance Move-up Procedure is developed to assure the
least possible response time to EMS requests . This procedure acts as a
guide for the County Ambulance Coordinator (Med-Com) .
Anytime an ambulance service area has no available ambulances , Med-Com
shall make every effort to move remaining ambulances to predesignated
locations . Med-Com may request an ambulancV unit move into another
services area if they feel this will ))rovide better ambulance coverage.
Because ambulance coverage in Service Areas Two, Three and Four is
limited to one unit, all ambulance requests , either emergency or
routine, require the implementation of the move-up system.
_The majordrawback to the move-up system is that when a unit moves in't"b
a move-up position, the response time to the unit ' s primary area
increases significantly in order to provide. improved response time to
the secondary'area.
All ambulance providers keep information on the number of times a unit
is required to respond into a move-up position. Because one ambulance
provider would not release information of their move-up activity, these
statistics are incomplete and are:Act reported in this ..study.
13
S-31
RESPONSE TIME STANDARDS
San Luis Obispo County -tu2v has no guidelines for response time
standards. The only reference in the area of response times made in the
Emergency Medical Response Manual is that of "reasonable response time. "
The development of standards to rate the performance of ambulance
providers first requires the rating of response areas as either urban,
rural , or remote.
The terms urban, rural , and remote are defined by the California State
Emergency Medical Services Authority as follows:
Urban : All census places with a population of 2,500 to 500,000 and a
population density of 100 to 999 persons per square mile; or census
tracts and enumeration districts with census tracts which have a
population density of 100 to 999 persons per square mile.
Rural : All census places with a population of less than 2 , 500 and
population density of 10 to 99 persons per square mile; or census tracts
or enumeration districts without census tracts which have a population
density of 10 to 99 persons -per square mile.
Remote : Census tracts or enumeration districts without census tracts
which have a population density of 5 to 9 persons per square mile.
Although the above demographic definitions woyld be applicable to San
Luis Obispo County, variations in population," geography or other
environmental factors may require adjustment with regard to service
delivery.
,
.i
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C-S-3o
The EMS Authority additionally defines these areas :
:"Metropolitan: Any unincorporated area with a population of 500 , 000 and
a population density of 1 ,000 or more persons per square mile .
Wilderness : Census tracts or enumeration districts without census
tracts which have a population density of less than five persons per
square mile.
If the EMS :authority' s definition of urban, rural, and remote .are
accepted locally, the cities and unincorporated areas of San Luis Obispo
County would be rated as follows based on California State Department of
Finance and San Luis Obispo County Planning Department figures :
Urban Areas Rural Areas Remote Areas
City of Arroyo Grande Adelaida California Valley/
City of Atascadero Avila Beach Simmler
City of Grover City Creston Cholame
City of Morro Bay Garden Farms La Panza
City of Paso Robles San Simeon Pozo
City of Pismo Beach Whitley Gardens * Oak Shores
City of San. Luis Obispo Santa Margarita * Shandon
Cambria San Miguel * Heritage Ranch
Cal Poly-
Cayucos - -
Baywood Park/Los Osos
Nipomo
Oceano
Templeton
Country Club ( SLO)
* - Shandon, Heritage Ranch and Oak Shores would normally be in the
rural category but are moved to the remote category due to their size,
limited number of EMS responses and location within the county.
is
C-6--33
t 1
In a 1984 document published by the State EMS Authority minimum and
recommended goals for setting emergency medical transport service area
were developed.
These minimum and recommended goals were developed through the committee
process with members consisting of public and private EMS providers
providing input..
These minimum goals are as follows:
Maximum response ,times .are not to exceed:
Urban: 10 minutes
Rural : 30 minutes
Remote : 60 minutes
The recommended goals are as follows:
Urban: 5 minutes.
Rural : 20 minutes
Remote : 45 minutes
To determine if the definitions set by the EMS Authority for urban ,
rural , and remote were reasonable, we sent to each local EMS agency in
California.
Fifty-eight local EMS- agenc-ies or regions were asked to respond to this
question :
"The State EMS Authority has developed minimum and recommended goals
for transportation of EMS patients. Do you think these goals are
reasonable
Of the 58 agencies or regions that responded, 55 or 95% ' felt the goals-
were reasonable.
a
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16
Nine EMS agencies ( 16% of those surveyed) have set criteria to rate
performance of ambulance transport services. The criteria are as
follows :
County Criteria
San Mateo urban < 9 minutes
Rural < 20 minutes
Monterey Urban < 8 minutes
Rural < 18 minutes
Santa Clara Urban < 10 minutes
Contra Costa Urban < 10 minutes
Rural < 20 minutes
Kern Urban < 8 minutes
Alameda Urban < 10 minutes
Inland Region' Urban < 10 minutes
Rural < 30 minutes
Remote < 60 minutes
i. Fresno Urban < 10 minutes
Rural < 30 minutes
Remote < 60 minutes
Tulare Urban < 10 minutes.
1 Inland Region consists of San Bernardino, Inyo, and Mono Counties.
From those counties and regions that have set response time standards ,
the standard response time for emergency medical transport service for
urban; areas is 8-10 minutes and 20=30yfor. °ruralrareas.
The American Heart Association has stated, "Even in the best of EMS
systems there is an inherent delay until the delivery of advanced
cardiac life support (ACLS) . The outcome for cardiac arrest, whether or
not bystander CPR has been initiated, is dismal if ACLS is delayed
beyond 8 minutes. "Z
ZTextbook of Advanced Cardiac Life Support, AHA, 1987
1
17
I evs-�
COMPLIANCE STANDARDS
To judge if an emergency medical transport system can meet response til._
standards , we must develop compliance standards.
These compliance standards would use response time statistics , drawn
from a computer base, to determine what percentage of the responses meet
established standards.
The EMS Authority has no recommendations for compliance standards .
Drawing from information received from the survey of local EMS agencies ,
eight counties or regions have set up compliance standards to be met by
emergency medical transportation services. These compliance standards
are as follows :
County Compliance Standards
San Mateo Urban < 9 minutes 90% of the time
Rural < 20 minutes 90% of the time
Monterey Urban < 8 minutes 90% of the time .
Rural < 18 minutes 90% of the time
Santa Clara Urban < 10 minutes 90% of the time
Contra Costa Urban < 10 minutes 90% of the time
Rural < 20 minutes 90% of the tide
Kern - Urban < 8 minutes 90% of the time
Urban < 12 minutes 100% of the time
Alameda Urban < 10 minutes 95% of the time
i
Inland Region' Urban < 10 minutes 90% of the- timb
Rural < 30 minutes 90% of-'ttietie
Remote < 60 minutes 90% of the time
Fresno Urban .. <. 10 minutes 95X. of..'-the--ti.me
Rural < 30 minutes 95% of the 'time
Remote < 60 minutes 95% of the time
Tulare Urbane';<.. 10 minute§ 90%"of the" ime�
1 The Inland Region consists of San Bernardino, Inyo and Mono Counties..
t
18
SUGGESTED LOCAL PERFORMANCE AND COMPLIANCE STANDARDS
The performance of ambulance providers for 1989 shown in Attachments 3-5
are based on the following criteria:
For urban areas identified on page 15 , the recommended response time is
< 8 minutes 90% of the time and <10 minutes 95% of the time.
For those rural areas identified on page 15 , the recommended response
time should be <20 minutes 90% of the time and for remote areas <60
minutes 90% of the time.
After researching .4 ,28O randomly selected_ Med-Com dispatch cards, it was
determined that on the average, it takes ambulance units L. 3 /111inutes
from the time of dispatch until the unit is enroute. Based on this
information , 1 minute has been added to all times compiled for this
study.
19
ATTACHMENT 1
DIVISION VII
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ATTACHMENT 2
C. Description of Service Areas. ,
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ATTACHM 3
URBAN AREAS - _ 198NCE RESPONSES C
1
Responses Responses - No. (%) No. (%) by No. (%)
Area/City Reviewed <8 mins. <10 mins. Other Unit by- BLS
Suggested Compliance 90% 95% N/A N/A
1 Cambria 285 265 (93%) 277 (97%) 8 ( 3%) 1 ( . 4%)
2 Paso Robles 631 462 (73%) 546 (87%) 73 ( 12%) 0 ( 0%)
Templeton 146 113 ( 77%) 137 (9.4%) 46 ( 32%) 0 ( 0%)
3 Morro Bay 557 504 (90%) 530 (95%) 109 ( 20% ) 0 (0%)
Cayucos 98 60 (61%) 76 ( 78%) 28 (28%) 1 ( 1%)
Bay. Park/L.0 344 50 ( 15%) 151 ( 44%) 60 ( 17%) 0 ( 0%)
i
4 Atascadero 669 472 ( 71%) 579 (87%) 94 ( 14%) 0 ( 0%)
5 S L Obispo 1185 ;986 (93%) 68 (6%) 49 ( 4%)
SL Cnty. Club 5 1 (20%) 2 ( 40%) 1 (20%) 0 ( 0% ) '
6 Grover City 281 .264 (94%) 271 (96%7 4 ( 1%) 23 { 8%)
PB/SBeach 276 258 (94%) 267 (97%) 5 ( 2%) 21 ( 8%)
Nipomo 131 20 ( 15%) 45 ( 34%) 2 (2%) 6 ( 5%)
Oceano
'114 99 (87%) 108 (95%) 2, (2%) 9 (8%)
1 - Means that number (%) of calls handled by a unit not based in that
-
area.
TOTAL EMS REPORTS REVIEWED FOR THIS STUDY 6769
22
ATTACHMENT 4
RURAL _AREAS - 1989 AMBULANCE RESPONSES
Responses 1
Responses No. (%) No. (%) by No. (%) by
Area/Citi• Reviewed <20 mins . Other Unit BLS Unit
Suggested Compliance 90% N/A N/A
1 San Simeon 38 38 ( 100%) 0 (0%) 0 (0%)
2 Whitley Gardens 16 14 (86%) 3 ( 19%) 0 ( 0% )
San Miguel 41 41 ( 100%) 2 ( 5%) 0 ( 0%)
3 NONE
4 Santa Margarita 32 29 (91%) 9 ( 28%) 1 ( 3%)
Garden Farms 9 9 ( 100%) 2 ( 22% ) 0 ( 0% )
Creston 21 16 (76%) 8 ( 38%) 0 ( 0%)
5 Avila Beach 65 63 (97%) 5 (8%) 0 ( 0%)
6 NONE
1 - Means that number (%) of calls handled by a unit not based in that
area.
TOTAL EMS REPORTS REVIEWED FOR THIS STUDY - 6769
23
ATTACHMENT 5
j 1
REMOTE AREAS - 1989_ AMBULANCE .RESPONSES
Responses 1
Responses No. (%) No. {9;) by No. (%) by
Area/City Reviewed <60 mins . Other Unit BLS Unit
Suggested Compliance 90% N/A N/A
1 NONE
2 Cholame 10 10 ( 100%) 1 ( 10%) 0 ( 0%)
Shandon 24 24 ( 100%) 2 ( 8%) 0 ( 0%)
Heritage Ranch 25 25 ( 100%) 3 ( 1'2%) 0 ( 0%)
Oak Shores 6 6 ( 100%) 1 ( 17%) 0 ( 0%)
3 NONE
4 Simmler 11 6 ( 55%) 3 (27%) 0 (0%)
La Panza3 3 ( 100%) 1 ( 33%) 0 _{ 0%) _ _. _
--
Pozo 18 18 ( 100%) 3 ( 17%) 0 ( 0%)
5 NONE
6 NONE
r
1 - means that number (%) of calls handled by a unit not based in that
area.
TOTAL EMS REPORTS REVIEWED FOR THIS STUDY - 6769
24.
�-, CONCLUSION
�. Is current ambulance service in the County adequate?
Based on available statistical data, there is the following degree
of compliance with the proposed guidelines in the various service areas of
the counts-:
Service Area Compliance Noncompliance
One (Cambria) Entire Area -------
Two ( Paso R. ) ------- .: Entire Area
Three (Morro B. ) Portions of Area Portions of Area
Four (Atascadero) ------- FntireArea .
�nt�i,.
Five (S.L.O. ) ------- - Area•
Six ( So . County) Portions of Area Portions of Area
- Are current ambulance service areas adequate?
The boundaries of current service areas appear reasonable because
they area consistent with the clustering of population centers and major
roads throughout the county. However, detailed :data_ to.-justify the
boundaries has not been developed. The EMS Agency has undertaken the task
of entering all ambulance responses into a geographical grid system. When.
this is completed, it will be possible: to examine existing boundaries on a
detailed basis to see if adjustments are indicated;.
Is it appropriate to use a paramedic ambulance to handle
non-emergency transfers? -
Yes, as long as suggested--response-`time�guidelines are met.
J _
25
C-54
r
. • - ' At what point in time should the County require additional ambul, ,e
services?
When the suggested response time
guidelines are not being met.
How should the presence of a first responder Advanced Life Support •
(ALS) fire Department affect ambulance response performance?
It is desirable to have ALS First Responders ( fire departments ) in
all parts of the County But the presence of ALS Fire Department response
should not affect the performance of ambulance service..
26
C-s-�
- Should Special Services Ambulance be granted an Ambulance License in
Ambulance Service Area Four?
A license should be denied at this time.
The publication of this study and dissemination of the guidelines
set forth herein represent a change in the regulatory framework . Although
the existing licensee in Area Four has not been meeting the proposed ,
guidelines concerning response times, it cannot be faulted for this
considering the following:
x Minimum response times are not set by state law, county
ordinance, or by the county Emergency Medical Response
Manual.
* Until now, EMSA has not officially recommended or requested
that response time guidelines be adopted .
* The Sheriff, as the county licensing official , has not
required the existing licensee to increase the level of
service.
The existing licensees should have an opportunity to develop and implement
plans for compliance with the new standards . To the extent they do not
develop and implement plans for compliance in a timely manner, it would be
appropriate to consider licensing additional providers in the affected
service areas
27
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